Lord Adonis: My Lords, in a Delphic passage of my Second Reading speech on the Education and Inspections Bill, I said that issues would be raised by this amendment for that Bill. I meant that, and we are considering the implications. However, the issue is not entirely straightforward. For example, almost all secondary schools and an increasing proportion of primary schools have schools councils, a development that we thoroughly welcome and to which we have given strong encouragement, including in the Education Act 2002. Geoff Whitty, director of the Institute of Education at the University of London, is conducting a review to look at how we can develop further our guidance in respect of schools councils, so there are other issues which need to be considered that are distinct from those related to provision for the under-fives. However, I recognise that we need to consider the implications of one Bill for the other, and we will do so.
	On that basis, I seem to have managed to unite the House at least at the beginning of our proceedings. I hope that that continues throughout our consideration of the later amendments.

Baroness Morris of Bolton: My Lords, I support the amendment. As the noble Baroness, Lady Walmsley, said, we have had long and detailed debates surrounding the issue of quality throughout the passage of the Bill. Gillian Pugh, in the book Contemporary Issues in the Early Years, states that the issue of quality has been discussed in every book on early childhood services during the past decade and has to be seen as a complex process rather than a tidy set of outcomes.
	However, just because something is complex does not mean that we should shy away from it. In Grand Committee, I attempted to define a measure of quality by referring to a 2004 National Audit Office report that identified the following indicators of quality: adult/child interaction that is responsive, affectionate and readily available; well trained staff who are committed to their work with children; facilities that are safe and sanitary and accessible to parents; ratios and group sizes that allow staff to interact appropriately with children; supervision that maintains consistency; and staff development that ensures continuity, stability and improving quality. In addition, of course, we have Ofsted, which the noble Baroness, Lady Walmsley, has covered in detail.
	But, whatever measure is used, I find it quite extraordinary that a Government who are always talking about high-quality childcare fail to put the word "quality" anywhere on the face of the Bill. The acceptance of the amendment would do much to allay the fear of many that the provision of sufficient and appropriate childcare by local authorities is in danger of becoming a tick-box activity.

Lord Adonis: My Lords, we are completely at one with the two noble Baronesses on the importance of quality childcare. In fact, the Bill makes explicit provision for that; the noble Baroness, Lady Morris, is quite wrong to suggest that it does not. Clauses 25, 50 and 61 all specifically mention the world "quality" and the structure, of the early years foundation stage has quality running all the way through it, so it is not correct to say that quality is not central to what we are seeking to achieve.
	Our argument against this amendment, which is why we will continue to resist it, is that there is no point in having one quality regime in place only to duplicate it and have another quality regime running alongside. The noble Baroness, Lady Walmsley, must have misunderstood me when she said that I was seeking to argue on the one hand that there was duplication and on the other that we were taking the role away from Ofsted. I was not for a moment suggesting that we should take the role away from Ofsted; it will stay with Ofsted. That role was given to Ofsted and taken away from local authorities, which had their own separate quality regimes until a few years ago. Therefore, if it stays with Ofsted, it will by definition be duplicated under the amendment.
	I am particularly surprised that the noble Baroness, Lady Morris, supports the amendment, because we believe that it will impose two quality regimes on providers, which will place a big set of new, additional burdens on them, particularly on private and voluntary sector providers, who may be less well equipped to meet additional burdens than state providers. Yet the noble Baroness says all the time that she is concerned about the degree of burden and the cost of enforcement obligations that we are placing on these providers. We cannot have it both ways. Either we want only the level of bureaucracy and red tape that is essential to maintain quality, or we go down the road of putting superfluous and duplicated obligations on providers, which will add to red tape. Once they are aware of it—they are not aware of it at the moment but they will become only too well aware of it if this regime is put in place—substantial concern will be aroused among the very private and voluntary sector providers about which the noble Baroness claims to be concerned.
	So far as quality is concerned, Part 3 of the Bill sets out the requirement on providers caring for children under the age of five to deliver the early years foundation stage. The Early Years Foundation Stage, the consultation document which I have circulated to noble Lords, sets out very clearly the quality standards that we expect all providers to meet and that Ofsted will inspect against. Its opening words in paragraph 1 say that,
	"the framework aims to increase coherence, provide a flexible approach to care and learning and raise quality throughout the Early Years Sector".
	Ofsted's duties could not be clearer in respect of quality in the Bill. Clause 31 says:
	"The Chief Inspector has the general duty of keeping the Secretary of State informed about . . . the quality and standards of regulated early years provision in England".
	Clause 50 states that individual reports on early years provision must include a,
	"report in writing on . . . the quality and standards of the early years provision",
	and Clause 61 states that, in respect of reports regarding later years provision,
	"the Chief Inspector may make a report in writing",
	on matters that he considers appropriate, including "the quality and standards" of that provision. Quality is mentioned throughout the Bill directly in those clauses and in the early years foundation stage, which has its force under the Bill.
	For provision for children over the age of five, the Ofsted childcare register will also require providers to meet specific quality standards, including qualification levels and adult-to-child ratio requirements. For providers not required to register, the requirements for receiving income from tax credits and the Ofsted endorsement which parents recognise and value will be major incentives in encouraging registration and quality.
	In respect of tax credits, Clause 6 requires local authorities to have particular regard to the need to secure sufficient childcare that is eligible for the childcare element of the working tax credit. Childcare will be eligible for tax credits only if it is operating to the standards set by Ofsted. Ofsted will be able to inspect all such provision to ensure that it is meeting those required standards. Furthermore, Clause 13 gives local authorities the powers and duties to provide information, advice and training to any providers or potential providers to help them to improve the quality of their care and meet the set requirements. This will include training on how to deliver the early years foundation stage, health and safety information and advice on how to ensure that care is accessible and inclusive. So if a provider is not delivering the high-quality care that parents expect, the local authority will be able to help them to improve.
	Similarly, with reference to the second half of the noble Baroness's amendment, if quality means suitability, Clauses 6 and 11 work together to ensure that the childcare needs of parents are understood and assessed and that action is then taken to meet those needs. By assessing the market through their Clause 11 duty, local authorities will be able to gain a good understanding of the standard of local childcare provision and the views and satisfaction of local parents. They will then be able to use this information to plan and secure sufficient childcare that responds to the needs of parents. As I said repeatedly in Grand Committee and on Report, care will not be deemed sufficient to meet the needs of parents if it is not suitable. By this, we mean suitable for all who need it in a locality, including black and minority ethnic families, disabled children, lower-income families or those who live in rural areas.
	We have considered this amendment very carefully, but there is no avoiding the fact that putting this duty on local authorities would inevitably require local authorities to assess the quality of provision, which could well lead to a duplication of the existing role of Ofsted. Worse, it could lead to two different inspection regimes operating on the same providers, which could particularly adversely affect the independent and voluntary sectors. Therefore, we do not feel able to accept the amendment.

Baroness Walmsley: My Lords, I think that on Report the Minister said both, but let us leave that aside for the moment.
	The suggestion that local authorities can assess the quantity of childcare without assessing the quality verges on the ridiculous. Without this amendment, the local authorities could do something as simple as saying, "In street A we have 100 places, in street B we have another 100 places, and in street C we have another 100 places, so the total is 300 places"—it could be just a totting-up exercise or a number-crunching exercise. At the very least, the local authority would have to check that each early years setting has a satisfactory Ofsted report. I hope that putting the word "quality" into the Bill, as I am trying to do today, would mean that the local authority would do a good deal more than that—but at the very least, it would have to do that.
	The Minister mentioned the private and voluntary sector, which is very much behind this amendment. People from the sector are very anxious that local authorities should understand the need for quality and are very distressed that Ofsted is not to look at the quality assurance programmes that many of them have in place. These are very much the drivers of ongoing improvement in the early years sector.
	The word "quality" may appear in some of the later clauses, but it is vital that the concept is more than implicit in all parts of the Bill, especially where we refer to local authorities' duties. It seems inconceivable that local authorities could carry out the duty to assess sufficient childcare without taking quality into consideration. It is very difficult to understand why the Minister does not feel able to accept this amendment, knowing the commitment that he has to improving the quality of childcare in this country and the commitment that the Government have put behind it in the form of money. For those reasons, I must test the opinion of the House.

Baroness Morris of Bolton: My Lords, I thank the Minister for his reply; the noble Baroness, Lady Walmsley, for her remarks; and the noble Baroness, Lady Howe of Idlicote, for clarifying matters. This is most emphatically not about a two-tier system and it is not a wrecking amendment. The Minister said that nothing would stop these settings charging outside the free entitlement, but that is what is happening now. They give not only the free entitlement of two and a half hours but three hours. That allows them to have the very children whom the Minister and the noble Baroness, Lady Walmsley, were talking about. They do not want to operate outside the system. They want to be part of the system. I do not think that the Government realise how much they have affected the dynamics of the childcare market, or to what extent a sector that until 1999 was relatively stable, is now uncertain.
	The Minister says that the Government are working with people in the sector and that it will be able to cope. Perhaps I may, without giving away the name of the lady or the nursery, quote an e-mail that is a plea for help and advice. She says:
	"I have a Montessori School in the Midlands. We have been running for 11 years and ever since the introduction of Nursery grants, we have charged the children the difference between our fees and the nursery grant. Today I have had a very strong letter from the Education Department of our council stating that we are absolutely NOT allowed, directly or indirectly to charge the children anything for 5 two and a half hour sessions. They have threatened the auditors to come in next year, if they think we are charging anything. The way things are financially, our income next term would only be enough to pay the rent and 1 staff's wages. Basically, we would have to close in 3 weeks time, if we do not charge. I am writing in desperation to ask if you are aware of any solution to this problem".
	If the Government really believe in choice and diversity of provision, they cannot stand by and enact legislation that will achieve the exact opposite. I do not doubt for one moment the Government's good intentions. However, we are dealing here with the law of unintended consequences. Perhaps the noble Baroness, Lady Walmsley, after hearing the Minister's remarks, will not support me in a vote, but I would like to think that I had done my best for people who have been providing childcare for 100 years. It might just concentrate the mind of the Government a little more. I should therefore like to test the will of the House.

Lord Northbourne: My Lords, what I seek from the Government is some modest support for grandparents and other close relatives, with whom a child does not live but who regularly provide childcare for him or intend to do so. Approximately 5 million grandparents today regularly provide some childcare for their grandchild at no cost to the state. Many make big sacrifices to free themselves to do this work. Some parents contribute to the costs, some cannot.
	Information, advice and training made available to grandparents could have several outcomes which would promote the Government's Every Child Matters agenda. For example, it would encourage some grandparents whose parenting skills are a bit rusty to take a refresher course. For those grandparents who sadly have never had the opportunity to learn the skills of parenting, it could break into that dreaded cycle of disadvantage and inappropriate parenting in some families. If good grandparental care is available, it is likely to reduce the demand for professional care, which is much more expensive for the state to provide.
	On Report, in response to my amendments, the noble Baroness disclosed that information, advice and training to be offered to childcare providers under Clause 13(1) is to be restricted by regulations to relate only or mainly to,
	"business support and sustainability and registration".—[Official Report, 12/6/06; col. 63.].
	If that is correct, it is depressing. I have to say that that report in Hansard is slightly at variance with what the noble Lord said this afternoon about the intention of regulations in Clause 13(1). It is incredibly difficult to make a useful contribution to a Bill of this sort without the regulations before us. We do not know what it is all about.
	Can it really be true that resources are to be diverted to giving child carers and future carers business advice but not helping them to do the job itself—the job of caring for the nation's children? However that may be, it does not affect my amendment as there is no reason that the information, advice and training given to grandparents under the proposed Clause 13(1)(a) should be governed by the same regulations as those for professional childcare. Regulations relating to the proposed Clause 13(1)(a) concerning grandparents could provide for grandparents to be given the services they need and deserve.
	Concern has been expressed by the Opposition parties about the possible cost of the amendment to local authorities. I believe that the amendment involves no irrevocable commitment to expenditure because the regulations could provide that all or part of the cost could be recovered from those who use the services.
	The Government expressed on Report their admiration and respect for the often selfless care carried out by grandparents caring regularly for their grandchildren. The approximately 5 million grandparents who provide such care will be watching the response to this debate to see whether the Government really mean what they say. I beg to move.

Baroness Howarth of Breckland: My Lords, as the unlikely founder of the Grandparents' Association, and along with the members of the all-party group, I support the noble Lord, Lord Northbourne. I shall of course wait until I hear what the Minister has to say in reply, but one issue is all-round costs and resources. I know of literally hundreds of families where grandparents look after their grandchildren. Very few of them are likely to avail themselves of local authority services. Most of them are extended families, which, despite all myths to the contrary, still exist in this country. We know that from the amount of care that is given. However, there are a few, which may very well be the ones that are more likely to need help, support and training. Indeed, I would hope that those families, which are often known to social services, would be encouraged to accept that help, support and training.
	I hope that that is what the Minister will say in reply. If so, I will be happy. But if grandparents cannot receive help when they need it, I shall be duly disappointed.

Baroness Walmsley: My Lords, like the noble Earl, Lord Listowel, I, too, had in mind the question asked earlier today by the noble Lord, Lord Adebowale, about the families in which the parents are either alcoholics or drug addicts. In many of those cases, the grandparents will have the burden of looking after the children. Yet they will not be considered to be the primary carers and will therefore not have the rights to training, information and advice that the primary carer with the parenting role would have.
	On the other hand, I am also very aware that many grandparents say that children are very different today and that things were different in their day. Many grandparents, faced with the job of looking after one of today's young people for extended periods, would greatly benefit from hearing from experts about the latest thinking on child development and how children have to face a very different world today from the one the grandparents faced when they were growing up or when they brought up their own children. There are many advantages to allowing grandparents to have access to the help, advice and information that is available to other people in the role of a parent.
	This is a very modest amendment in the direction in which the noble Lord, Lord Northbourne, would really like to go eventually. It would not preclude the local authorities from making a modest charge for these services if there was an additional financial burden. I really do not think there is anything in it that would prevent them making such a charge. I see no major spending commitment in an amendment such as this one, so I really do commend it to the Minister.

Lord Adonis: My Lords, I shall also speak to Amendments Nos. 6, 7 and 8. These are minor and drafting changes. Amendments Nos. 5 to 7 correct the drafting in Clause 73 to make it absolutely clear that that the provisions in subsections (5) and (7) regarding the registration or deregistration of provision refer to the recipient of a notice from Her Majesty's Chief Inspector.
	Amendment No. 8 is a wonderful drafting correction on which to end our proceedings. It relates to Schedule 2, which amends the Education Act 1996 by correcting the wording to refer to a nursery in "England or Wales" rather than in "England and Wales", as the Bill now states. It became apparent that very few nurseries would fulfil that requirement. I am glad that our final act in respect of this Bill is to ensure that England or Wales will satisfactorily meet those provisions. I beg to move.

Earl Howe: My Lords, we had some extremely useful and constructive debates in Grand Committee on the issue of pharmacy supervision, and I return to the subject only briefly because there are perhaps two or three points on which we did not reach as definitive a conclusion as we might ideally have wished. Against that background, I hope the Minister will have guessed that Amendment No. 30, being a rather hackneyed format, is designed purely as a probe.
	One of the profession's main worries—I mention, in particular, the Pharmacists' Defence Association—is the extent to which it is reasonable to allow the pharmacist to be absent from the pharmacy whilst still ensuring that patient safety is not compromised. The Minister made some helpful comments in Grand Committee on remote supervision and the use of technology in improving patients' access to medicines. I am sure he is right that, as time goes on, we shall see the development of this technology which, in places such as Australia, where distances are very large, probably has an important part to play in ensuring that patients' needs are looked after. However, in Britain, the arguments for embracing this kind of technology are less strong because pharmacies, as a rule, are no more than a short car or bus ride away from a patient. Many members of the profession feel that the use of technology should not be encouraged as a substitute for pharmacists being physically present in a pharmacy because technology, however good it is, merely introduces new challenges for the maintenance of patient safety. Pharmacists cited a case in California where 4,700 people received incorrect medication when a dispensing robot went wrong.
	At a broader level, we need to be clear how we justify the absence of the pharmacist from the pharmacy and in what circumstances. Clearly, as we debated before, there are frequently good reasons why a pharmacist in the course of his professional duties has to be allowed to leave the chemist's shop. But the watchword here, as the Minister himself emphasised, must always be patient safety. The Pharmacists' Defence Association has advised me of a suggestion by the department of fixing a predetermined percentage of the working day as the maximum period for which the pharmacist will be allowed to be absent from the premises.
	Personally, I am very doubtful whether a hard-and-fast percentage is the right approach, because having chosen a figure it is always possible to argue for a figure that is higher or lower in different circumstances. A fixed percentage such as 20 per cent is bound to be arbitrary. But we surely need to ask a more fundamental question: whether and to what extent supervision can ever properly take place when the pharmacist is not physically present.
	Let us leave aside remote supervision through the use of technology, which I have already covered. If a pharmacist is absent from the pharmacy, to what extent is it safe for him to rely on support staff to follow the rules laid down in standard operating procedures? The PDA tells me that it regularly encounters incidents of support staff acting outside their competences and putting patient safety at risk. That is surely worrying. So in creating flexibility for pharmacists to be absent, which on one level I understand the need for very well, we ought to keep in mind that there is an inevitable trade-off for that flexibility in the form of a potential risk to patient safety. None of us wants to see that compromised. If an arbitrary percentage of "absent time" were proposed, it would need to be closely justified by reference to the patient safety principle.
	The regulations will deal with the finer details, but I should be most grateful to hear from the Minister a little more of how the Government propose to square this circle. I beg to move.

Lord Warner: My Lords, Clause 26(1) inserts new subsection (7A) into Section 10 of the Medicines Act 1968. It enables us to make clear what a pharmacist has to do to satisfy the supervision requirements in respect of the preparation and assembly of medicines. Through this power we can specify which activities pharmacists must undertake themselves and when aspects of the preparation and assembly of a medicine can be delegated to other trained and competent pharmacy staff working under the supervision of the pharmacist. This power also enables us to prescribe conditions that must be met where a pharmacist supervises these activities remotely. However, the power does not relate to our proposals to enable the responsible pharmacist to delegate certain aspects of supervision for suitably trained and registered health professionals such as pharmacy technicians, which can already be achieved using order-making powers in the Medicines Act.
	I accept the spirit in which the noble Earl moved his amendment—to find out a little more about what we are up to in this area, if I may put it that way. Certainly, the exercise of the pharmacist's responsibilities is not wholly dependent on his or her physical presence in the pharmacy at all times. I reassure the noble Earl that we recognise the need for parameters to be set on the pharmacist's absence, but they should not, as now, constrain the pharmacist from using his extensive clinical training to offer services away from the pharmacy and working with other health professionals in the community.
	It is important that the pharmacy is seen as the responsible pharmacist's main place of work, where he will spend most of his working time to exercise fully his responsibility for the safe and effective running of the pharmacy. However, like the noble Earl, I am not wildly enthused about fixing a minimum percentage of time; that would be arbitrary and would not deal with the range of circumstances that may exist. We intend to set out in the regulations the circumstances and conditions supporting the pharmacist's absence from the pharmacy—for example, for arrangements to be in place for pharmacy staff to contact the responsible pharmacist when he is away from the pharmacy, or another available pharmacist, to provide advice.
	I assure the noble Earl and the House that we shall consult extensively on the development of the regulations in due course. In the mean time, we outlined how they might develop in an information paper published in January. If the noble Earl has not seen the paper, I can send it to him and to other noble Lords. We shall proceed with great care and caution in this area and will do so in full consultation with the pharmacists' interests. We believe that this issue needs to be thrashed out in the consultation on the regulations, and I hope that the noble Earl will be more reassured by what I have said.

Earl Howe: My Lords, the noble Baroness, Lady Barker, has made some powerful points, and I agreed with much of what she said.
	I want to come at this issue from a slightly different angle. In Grand Committee the Minister gave some welcome reassurances on the general principle of one pharmacist/one pharmacy, which I and other noble Lords believe is right. However, the trick the Bill needs to pull off is both to safeguard that general principle while not closing the door to evolution in how pharmacies are run. We are living through a time of considerable change for pharmacy, and it would be unwise to set in stone provisions that do not allow for a certain amount of flexibility within the confines of one pharmacist/one pharmacy.
	I cite one example. A major pharmacy group is working on a hub-and-spoke idea for dispensing prescriptions. The prescriptions arrive at a central pharmacy, either electronically or from an outlying pharmacy where the patient is. That central pharmacy then dispenses under the supervision of a pharmacist. It then sends the medicines to the outlying pharmacy to be handed to the patient by the pharmacist in that shop; in other words, there is no loss of supervision at any stage of the process. But I suggest that it is the pharmacist at the centre who is really acting as the responsible pharmacist within the terms of the Bill.
	The point of that idea is to free up time for providing services in the "spoke" pharmacies. The pharmacist at the centre plays a superintending role over the other pharmacies in the cluster, but each of those has a pharmacist in them. That is a variation on the theme of one pharmacist per pharmacy. While I hope no one would take issue with the arrangement from a patient safety perspective, the lines are rather blurred, strictly speaking, as to who the responsible pharmacist in that example actually is. Again, we are dependent on the regulations to see how and in what circumstances the Government are prepared to relax the one pharmacist per pharmacy rule.
	The Minister will need to take care not to go faster than the profession wishes to go, but at the same time to leave room for sensible variations within a framework of maintaining patient safety. That is not by any means an easy balance to strike, but I do not believe it is impossible.

Lord Warner: My Lords, before I deploy my argument, I have a terrible feeling that I may not convince the noble Earl. However, I will attempt to go through this in a bit more detail, in the hope that I can persuade him that we are behaving reasonably.
	When determining chemist applications to provide NHS pharmaceutical services, legislation means that primary care trusts cannot take into account any additional services that the chemist might offer. The Government committed to changing this as part of their balanced package of measures responding to the Office of Fair Trading's report into retail pharmacies. That is how we came into this issue.
	Until recently, NHS pharmaceutical services, as defined under the National Health Service Act 1977, primarily comprised the supply of drugs, medicines and listed appliances. It is important to hang on to the fact that we are changing the range of services which can be taken into account in the kind of situations under discussion. However, with the introduction of the new contractual framework for NHS community pharmacies in April 2005, pharmacists are required to provide other essential services, such as promoting healthy lifestyles and support for self-care, linked to the dispensing of medicines. It is an additional range, but, inevitably, some of that continues to be linked to the dispensing of medicines. These new changes aim to improve choice and convenience for patients and help reduce reliance on NHS services.
	Sales of over-the-counter medicines and other related healthcare products have been estimated to account for 10 per cent of a typical pharmacy's turnover, compared with 80 per cent derived from NHS prescription business. Important though over-the-counter medicines are, they are a relatively small proportion of the turnover of the business in this context. Although I accept that the range of medicines available over the counter is being significantly extended—so one would possibly expect that balance to change—it is still a relatively small proportion of the total income of a typical pharmacy's turnover. Such sales are, of course, private transactions and, as such, do not come under the requirements for pharmaceutical services under the NHS Act. Nevertheless, as services, they are closely related to other services we are interested in, particularly the requirement on pharmacies to support patient self-care as an essential NHS service.
	I fully accept that over-the-counter medicines are an important part of helping patients to take more responsibility for self-care. I am not dismissing their role, but putting it into context: they are a relatively small proportion of the total turnover.
	We therefore consulted further on this complex issue last summer, on the proposal to enable primary care trusts to consider, in their assessment of chemist applications, what improvements they could bring to the provision of, or access to, over-the-counter medicines and other healthcare products. Expanding consideration in this way would, for the first time, capture this aspect of a chemist's activity within the primary care trust's overall assessment of chemist applications.
	Appropriately in Wimbledon week, the noble Earl talked about tie-breaks. I emphasise that this new provision will come into play only where a primary care trust is assessing two or more applications together. They must all pass the "necessary or desirable" test, but it would not be necessary or desirable to grant them all. This will occur in a competitive situation when applications take place at the same time.
	This amendment would enable primary care trusts to consider only the range of over-the-counter medicines and other healthcare products each applicant sells and the advice it gives. As I understand the noble Earl, his point was that it would remove the ability of primary care trusts to consider price or discounts. I stress that our proposal is not simply about cheaper or cut-price medicines and that primary care trusts' considerations in these matters will not be solely financial, for the reasons I have given. While price can obviously be a factor, it is not, nor will it be, the primary determining factor. Our proposal goes much wider. It centres on improvements in access to a wide range of health-related products, including medicines, and the support and advice available to the patient to go with that supply. The primary care trust will take account of that wider range of considerations in deciding between rival applications.
	Our proposal is not about comparing the discounts that companies can gain from wholesalers but about trying to get the best range of services available to patients in a particular set of circumstances. With consultees' indication that discounts would also be open to smaller pharmacies through access to larger wholesale-buying groups, it is about patients' access to over-the-counter medicines and healthcare products—and access also means affordability. We cannot get away from the fact that the price of a product has some impact on its affordability and its accessibility to patients. Primary care trusts therefore need to be able to take into account prices of products when assessing applications. I again emphasise that a wide range of considerations will be made, not just the price of over-the-counter medicines, and that that consideration will happen in the limited set of circumstances when rival applications are being determined at the same time.
	I do not accept the noble Earl's essential that the price of over-the-counter medicines will be a dominating factor. He is implying that that will skew the decisions. Price is just one factor, not necessarily the main one, in determining which application a PCT will accept. It is worth putting on the record that the National Assembly for Wales, while it did not accept the recommendations in the Office of Fair Trading report and has not introduced the regulatory reforms now in place in England, has decided to implement this proposal for NHS pharmaceutical services. The clause therefore contains an equivalent provision for Wales.
	I am still slightly unclear whether the noble Earl is on the side of a free and open market, in which case the PCT's ability to take price into account is surely important, or whether he is concerned about patients, in which case price remains important but should not be the only factor. I say that price is one factor among many others. We think that our clause strikes the balance between price, which is good for patients, and wider support services, which are also good for patients. It is a balanced judgment, and we think our proposal is balanced. I hope that I have given some comfort to the noble Earl and the noble Baroness, Lady Barker.

Lord Warner: I do not think that there is any issue between me and the noble Earl. We are committed to consultation on the regulations and I am happy to make the commitment that there will be full consultation on regulations on general ophthalmic services contracts with representatives of providers of ophthalmic services. We do not think it necessary for that to be in the Bill. That has not been previous practice and such a requirement is not in primary legislation for current general ophthalmic services, nor for medicine, dentistry or pharmacy. We see no reason why it should be necessary in this case. However, I emphasise that we will have full consultation with the profession on the regulations before they are made.
	It is important also to make the point that we intend to consult with other bodies on certain contractual issues. For example, in relation to exclusion from holding a contract, we would consult with the Counter Fraud and Security Management Service, as one reason for exclusion is likely to be a history of fraud. So there will be a wider range of people whom we want to consult. However, that does not diminish in any way our firm commitment, which I am happy to repeat, that we will have full consultation on the regulations. We think it unnecessary to provide for that in the Bill. I hope that that gives the noble Earl the reassurance for which he was looking.

Lord Warner: My Lords, government amendments Nos. 40 and 41 are minor amendments to allow those appointed to the Health and Social Care Appointments Committee to be treated in the same way as the non-executive members of the appointments commission. Schedule 4 provides for regulations prescribing the conditions and disqualifications that apply to the non-executive members of the commission. These regulations may also make provision for the terms on which non-executive members are appointed. Similar provision has also been made for regulations to make provision for the terms on which the health and social care commissioners are appointed. However, the power to make regulations prescribing conditions and disqualifications has not been replicated.
	At least one, and up to four, of the health and social care commissioners must also be appointed as a non-executive member. Under the terms of the Bill as currently drafted, therefore, it would be possible to prescribe the conditions and disqualifications that applied to those commissioners who were non-executives but not to the remaining commissioners. These amendments therefore allow conditions and disqualifications to be applied to all the health and social care commissioners. Government Amendments Nos. 42, 43, 47 and 48 are purely drafting technical amendments. I beg to move.

Lord Warner: My Lords, I certainly agree with the noble Lord, Lord Palmer, that patients should be as well informed as possible about the NHS services they receive to enable them to make informed decisions about their treatment. Making them aware of the cost of their prescription medicines would probably contribute to that and might reduce waste if patients are less inclined to reorder repeat prescriptions that are not required. However, while I am sympathetic to some of the underlying arguments behind the new clause, I have to say to the noble Lord that life is not quite as simple as he suggests and that there would be a number of practical problems, which mean that I am unable to support it.
	First, changes to primary legislation are not required in order to effect the change the noble Lord intends here. The amendment would enshrine a regulatory change in primary legislation with no flexibility to amend the regulation by secondary legislation if that were required in the future. That is of particular concern because the effect of this measure on patients is as yet unknown. It may, for example, discourage some from taking their medication—a particular risk among elderly patients, I should think. Further, we may find that providing information on the label may not be the most appropriate way to identify the cost to a patient.
	Secondly, the scope of this amendment means that it would affect many more areas of the NHS than just prescriptions dispensed by a pharmacy or a dispensing doctor in primary care. It would affect, for example, prescriptions dispensed by appliance contractors and out-of-hours service providers, prescriptions dispensed to hospital outpatients, treatments from walk-in centres, as well as those resulting from patient group directions. So it would range widely over a varied set of circumstances relating to patients. This would add to the complexity and cost of implementing such an arrangement.
	I have to say to the noble Lord that this is not a cost-free option. All dispensing contractors and suppliers of medicines would need to have mechanisms in place to establish a price and label their medicines appropriately. In most cases this would mean upgrading their computer software to print prices on dispensing labels, and computer pricing databases would need to be kept up to date. It is also expected, especially to begin with, that patients would ask about the price indicated on the label. Given that, I think that I have said enough to suggest that simply pressing a button would not be the way one could introduce this measure. I have further arguments along these lines but I will not delight the noble Lord with them. However, I am happy to give him a fuller set of arguments.
	Lastly, I want to point out that what is meant by the "full retail cost" is not clear. While suppliers publish a list price for a product, that is not necessarily the cost to the NHS of supplying it to the patient. The cost of supplying a product to the patient from a dispensing contractor, for example, would need to take into account any service fee provided to the contractor, along with any discount arrangements and additional expenses that may be claimed. Dispensers would not be in a position to know all these details, so further practical problems would arise in that area.
	On balance, I believe that the amendment should be rejected because of its legislative inflexibility, the risk that it may discourage some patients from taking vital medicines, and the very considerable practical problems and costs which it would create. I am sorry to disappoint the noble Lord in that response, but life is just a bit more complicated than he may have thought when he tabled the amendment.

Amendment, by leave, withdrawn.
	Clause 79 [Orders and regulations]

Lord Monson: At first glance, this may seem like a purely technical and perhaps even trivial amendment. It is nothing of the sort. If it is agreed, it has the potential, first, to save the livelihood of a number of licensees who may be struggling financially, perhaps because they are sited in out-of-the-way locations and, secondly, to make all the difference to the comfort and wellbeing of those 45 per cent of pub customers who enjoy a pipe, cigar or cigarette with their pint.
	The amendment effectively relates to the question of what constitutes "substantially enclosed", which are places where, if the Bill remains unamended, smoking will no longer be permitted. When this issue was raised in Grand Committee, the Minister argued that the precise definition of "substantially enclosed" would be highly technical and accordingly best left to the negative resolution procedure—in contrast, let it be noted, to all the other proposed regulations in the Bill. However, he then revealed that the revised regulations—revised since last summer—that the Government had in mind for England were not at all complex or technical, but very simple and straightforward. They state that at least 50 per cent of the wall area of any room or other space to be exempted from the smoking ban would have to be open to the wind and rain. That applies to England only. The Welsh, through the medium of the Welsh Assembly, will be allowed to decide on their own formula. They could resolve that only 20 per cent to 25 per cent of the wall area needs to be open, or at the other extreme, that 70 per cent to 75 per cent of the perimeter wall must be exposed to the elements.
	We must concern ourselves this evening solely with England. We—by which I include the noble Baroness, Lady Boothroyd, who strongly supports the amendment and would have added her name to it had she been able to be present—submit that it is not necessary to declare that as much as 50 per cent of wall space must be open to the elements in order to protect employees. We should remember that, as it stands, the Bill will bite even where there are no employees. For example, it will hit a small partnership or even a husband and wife team, where both parties enjoy a cigarette equally. The Bill insists that they be protected from one another even if they have no wish to be so protected.
	The Government will no doubt argue that having 50 per cent of wall space open to the elements is unlikely to cause a problem on most summer days and on many late spring and early autumn days as well. I would not disagree. However, the winter months will be absolute hell—if hell can embrace being half frozen to death. High-level radiant heaters can help on a cold, still day when there is no wind or rain, but we do not get many such days in our Atlantic climate.
	The problem is that this is a Henry VIII Bill. I can well imagine the caustic comments that our late good friend Jack Simon, Lord Simon of Glaisdale, would have delivered had he still been with us. Henry VIII Bills deserve the closest parliamentary scrutiny. Giving both Houses more indirect input into the final regulations via the affirmative procedure would not necessarily result in a more equitable solution but it could, whereas the negative procedure would rule out any chance of effective parliamentary pressure.
	I hope that the Government will reconsider and accept this amendment, not least because it will rectify an anomaly, in that all the other regulations proposed in the Bill, many of relatively minor importance compared to this one, are subject to the affirmative procedure. If, sadly, they do not feel able to, I hope that the official Opposition will. For many years now, the Conservative logo has been the torch of freedom—or that is what I interpret it to be. One has read that the present leadership considers that logo to be out of date and is considering replacing it. I trust that that is not indicative of any weakening of enthusiasm for individual rights and freedoms—in particular, the individual rights and freedoms of unfashionable minorities. If the Government hold firm, I hope that the Opposition will join us in the Division Lobby. I beg to move.

Lord Warner: My Lords, Government Amendment No. 49 commences all provisions in the Bill containing regulation and order-making powers, including any definitions relevant to the exercise of any such powers on Royal Assent. I originally tabled this amendment in Grand Committee, but my noble friend Lady Royall agreed to withdraw it in order to give absent friends—if I may put it that way—the opportunity to hear the explanation at Report stage.
	There is a convention that the provisions of an Act of Parliament should not normally be commenced until at least two months after Royal Assent. The purpose of the convention is to ensure that those who are affected by a legislative change have sufficient advance warning of that change in legislation to be able to adjust their behaviour accordingly. This is conducive both to ensuring that the law is applied in a fair way and to preserving legal certainty.
	In this respect, the Health Bill will be no exception, with Clause 83(1) setting out just a few technical provisions that are needed mainly to make the Act, which will come into force on Royal Assent, work. The provisions in Clause 74, on "Transfer of criminal liabilities", will also come into force on Royal Assent, as it is entirely in the public interest for there to be no undue delay in the provisions taking legal effect.
	However, the Government's view is that the commencement of regulation-making powers, either on Royal Assent or shortly after, does not breach the convention, provided that the coming into force date of the regulations does not fall within the two-month period governed by the convention. It is only when the regulations come into force that they have any legal effect.
	As I am sure the House will appreciate, it is often desirable to be able to make regulations well in advance of the main provisions of an Act coming into force. For example, in relation to the smoke-free regulations permitted under Part 1, Chapter 1, it is clearly in the interests of industry to have sight of the final content of the regulations as far in advance of the summer 2007 implementation/coming-into-force date as is possible. It would, therefore, make no sense if regulations were ready to go, but could not be made or, in the case of any affirmative regulations, scrutinised by Parliament, until two months after Royal Assent. That would be to no one's benefit.
	The Bill, as currently drafted, would already allow us to commence such regulation-making powers early through the laying of separate commencement orders—in other words, orders that simply switched on the powers to make regulations in advance of the main provisions being commenced. However, we believe that such an approach would be unnecessarily bureaucratic and unhelpful to the reader of the Act, who would be required to search out extra commencement orders which did nothing apart from switch on regulation-making powers.
	Amendment No. 49, therefore, automatically "switches on" all regulation and order-making powers within the Bill on Royal Assent. We believe that this is a much less bureaucratic approach than going down the route of individual commencement orders and will provide greater clarity to the Act. Of course, in line with the convention, any regulations would not have a coming-into-force date sooner than two months after Royal Assent.
	Given that no one stands to gain anything from the switching on of regulation-making powers through separate commencement orders, we have decided to try to apply the amendment to all subordinate legislation within the Bill, with the exception of Clause 36(2). The Scottish Executive have indicated their wish to retain control over when that provision is commenced.
	It is important to emphasise that the making of regulations is not the same as the coming-into-force date of regulations. The amendment does not permit us to do anything that we cannot already achieve through other means; it is simply about removing an unnecessary layer of bureaucracy and providing greater clarity to the Act, as the reader would not be required to search out extra commencement orders which did nothing more than switch on regulation-making powers.
	Finally, it is also worth adding that a similar provision was included in the Health and Social Care (Community Health and Standards) Act 2003. I am not sure why we did not include such a provision in the Bill from the outset, but it is before us now, and with the explanation that I have given at some length, because noble Lords were concerned about the matter, I hope that noble Lords will support the amendment. I beg to move.

Lord Warner: My Lords, first, I shall deal with the points raised by the noble Earl, Lord Howe. I can assure the noble Earl that the draft regulations will be published very soon. The timescales, much further into the year, of which he may have been thinking, are probably not right. I cannot give him a precise date, but it will be very soon. It is worth reiterating that we have already announced many definitions here, as in Scotland, so that people can begin the planning work. I cannot give him—I suspect the noble Earl would not expect me to—a categoric assurance about July 2007; at present, I can say nothing more than the summer of 2007. We are talking to the industry about implementation, including dates. An announcement will be made as soon as possible, but I cannot go further than the position we have already reiterated. The summer of 2007 is the period that we have in mind.
	The noble Lord, Lord Stoddart, raised the issue of Clause 4. I believe I am a slightly misunderstood man. Earlier during Report stage, I put forward limitations on the provisions in Clause 4. I was asked, I merely happened to give some examples about the circumstances in which the regulations might be applied—I emphasise "might be applied". They would have to pass a significant risk test in the amendment that we put forward, so we have made Clause 4 more restrictive in its regulation-making capacity than was originally proposed. I was not expecting a great deal of thanks from the noble Lord, Lord Stoddart, but I thought I should correct the record.

The Earl of Listowel: rose to ask Her Majesty's Government what is their strategy for children's homes.
	My Lords, I hope it may helpful if I first provide some context for the subject of this debate, the evolution of children's homes and their international context. I shall then examine some of the strengths and weaknesses of current government policy. Underpinning this is a concern that Her Majesty's Government take a more strategic grasp on this challenging area of policy. I shall read from my notes, because there is a lot of ground to cover in a short time.
	A turning point in the history of children's homes was the Seebohm report of 1968. There followed the move from specialist to generic social care. According to Wolmar, the author of Forgotten Children: the Secret Abuse Scandal in Children's Homes, this signalled the loss of specialism in residential childcare. I hear from those working at that time that many of the best managers in children's homes chose then to move from residential care to management of the new social service departments. It was intended that residential childcare workers would be required to have the new social work qualification. That did not happen, perhaps because of the cost it would have incurred.
	At the same time, there was a large increase in children coming into care and, by 1975, there were 34,600 children in residential care. That same year, a period of national austerity began. Starved services and poorly qualified and supported staff provided part of the context for the abuse scandals that followed: Beckford, Pindown and Kincora, to name but a few. A regular attender of the Associate Parliamentary Group for Children and Young People In and Leaving Care, Mark Belsham, described to me his experience of a children's home in, I think, the 1970s. One of the staff regularly took one of the boys from the dormitories at night. The boy later hanged himself, and was discovered by Mark Belsham and his fellow residents. In his account, Christian Wolmar expressed his surprise that no audit was kept of the number of abuse cases over this time.
	Moving to the 1990s, Norman Warner, now the noble Lord, Lord Warner, produced his report on staff recruitment and training, Choosing with Care, and Sir William Utting produced his two reports. In his opening remarks to People Like Us, Sir William urges that the best safeguard for children is an environment of overall excellence. The new Labour Government took their cue from Sir William and entitled their first ring-fenced spending programme on looked-after children: Quality Protects. Sir William Utting produced a follow-up report, finding that safeguards had significantly improved and that children's homes were far more open. He emphasised the need for looked-after children to have a range of appropriate placements, including good quality residential placements. Again, the Government took their cue from him and entitled their second programme of investment and change to commissioning: Choice Protects.
	However, partly because the reputation of children's homes had become so tainted, the number of placements has now declined to 8,550. Generally speaking, these are now the children who have experienced the most disruption and who are the most challenging to work with. Yet, in 1998, 70 per cent to 80 per cent of staff had no relevant qualification. The Government have set a target of 80 per cent of the workforce to have an NVQ level 3. I would be grateful if the Minister will write to me with details of how that is progressing.
	Perhaps I may now move from the historical to the international context. Across the English-speaking world, where standards of staff qualifications tend to be variable and are often poor, there are similar histories of abuse. Other than Belgium, I am not aware of such patterns in Europe. The Department for Education and Skills has funded research into residential childcare in Denmark and Germany. Their staff are known as pedagogues. About two-thirds of staff in Danish children's homes have completed a three-year higher education qualification. There are few job vacancies, and it is a highly esteemed profession. In France, Germany and Denmark, it seems to be fair to say that they place their best professionals with their most vulnerable, needy children. About 50 per cent of looked-after children in those countries are in residential care—they have such faith in it. In France, at least, the main focus is on reintegrating children with their families. The expertise of the home is used to support parents and children. Where reintegration is not possible, young people may continue in their residential home into their late 20s, if they wish to do so.
	Researchers asked pedagogues what was their first duty to their children. Upwards of 80 per cent of Danes said that it was to support their children. About 95 per cent of Germans gave a similar response, as did about 41 per cent of English residential childcare workers. By contrast, 59 per cent of the British placed first the need to follow procedure. That suggests that less-qualified English staff lack the confidence to provide the emotional support to their children that Germans and Danes can. When I told a German pedagogue that English residential childcare workers were directed not to travel alone in a car with a child, he laughed in surprise. I have spoken with very experienced practitioners in this country, and when I saw one of them give a child a hug, he felt that he had to give an explanation for his behaviour.
	So, that is the context. A lack of strategic thinking led to a situation in which our most vulnerable children were cared for by our least qualified and supported carers. The situation must at least have contributed to the widespread historic abuse of children in care.
	What have the Government done to remedy the situation? I have already mentioned the very welcome Quality Protects and Choice Protects programmes. The establishment of the Commission for Social Care Inspection has been welcomed by children's homes managers because it enables them to have more control of the admission of children and allows them to ensure a balanced clientele, rather than simply having to respond to crisis admissions from local authorities. There are many highly experienced and dedicated people in the field, and research suggests that morale is remarkably good given the circumstances. Even so, vacancies are at upwards of 11 per cent in children's home, and double that in London. That is significantly higher than vacancy rates for family and child social workers.
	The introduction of children's trusts and their boost to multi-agency working should strengthen the role and effectiveness of residential childcare. The promotion of multi-disciplinary team working—teachers, nurses and social workers functioning within a children's home—is much to be welcomed. The Government's funding of the National Centre for Excellence in Residential Child Care is also most welcome.
	However, what are the current weaknesses? The most immediate and obvious is the apparent ineffectiveness of the strategy for commissioning good-quality placements. Short-term thinking seems to be allowing some of the bad providers to drive out some of the good. The Independent Children's Homes Association says that,
	"many of the models that influence purchasing strategies in a significant number of areas are more applicable to the purchasing of manufactured goods than to the purchase of childcare resources".
	The ICHA believes,
	"that there is a crisis in childcare fuelled by very significant examples of appalling childcare practice where the needs of the budget holder or performance targets override the interests of the child".
	That concern is widely held within the sector and not just by the independents.
	I shall conclude as I see the time. I look forward to hearing my noble friend Lord Ramsbotham perhaps discuss the role that children's homes can play in keeping children out of custody. I also hope that the Minister will find this debate helpful in the preparation of the forthcoming looked-after children Green Paper. Looking back, one can see how the lack of a strategy contributed to the abuses of children in care. As I say, there is considerable concern about the commissioning of residential childcare. I hope the Minister will say what more is being contemplated to encourage regional commissioning.
	Although I welcome the NVQs in childcare, the professional capacity of residential childcare workers is still profoundly lacking. Will the Minister consider a transformation fund for residential childcare similar to that for early-years childcare workers? Residential childcare caters to such a wide range of children with varying needs. Children's homes need a clear focus and purpose. Will the Minister consider encouraging the introduction of tiered provision catering to different levels of need? I am most grateful to noble Lords who, at such short notice, will be contributing to this debate, and I look forward to the Minister's response.

Baroness Walmsley: My Lords, I thank the noble Earl, Lord Listowel, for introducing the debate. I do not know where your Lordships' House would be without him to raise the voice of these most disadvantaged children. He does a wonderful job.
	There is some good news about children's homes. Children can enjoy living in good children's homes. Their behaviour can be significantly modified and improved in good children's homes. Some children prefer them because they feel threatened by a family environment, and they prefer to have a peer group—other young people who can understand how they feel and who feel the same way—in the same establishment. Some young people can gain education and skills and tackle long-standing health problems in good children's homes. The trouble is that not all our children's homes come up to the standards that we would all want for all our children.
	Many organisations representing children are united in the improvements they call for. They would like to see the voice of the child in care treated with a great deal more importance, the children treated as individuals with brains, feelings and wishes, and provided with more stability. They would like local authorities to stop changing the children's placements, not make them subject to policy changes in their local authority, try to reduce the turnover of staff so that children can develop strong relationships, and stop moving them from school to school.
	Organisations are also asking for more independent representation and for someone whom young people can regard as a confidante, especially when they are in trouble. Specifically, a young person who runs away from a children's home and then comes back needs someone independent who they can talk to about why they ran away and, perhaps, why they came back, and who could look at those causes to see how they might be addressed.
	On education, it is salutary to remember that we are spending £2 billion on children in care, yet only 8 per cent of them get five good GCSEs. Only 1 per cent go on to higher education. I know that the Government are turning their attention to that appalling track record. I welcome the new duties on schools to promote the educational attainment of children in care and the new duty in the Education and Inspections Bill, which has just come to your Lordships' House, to force a school to take a child who has been excluded from two other schools. We cannot have those children going around searching for a school that is prepared to take them.
	However, the issue is not just admissions. We have to remember that 60 per cent of children in public care have suffered neglect or abuse. They are very damaged both physically and emotionally, and sometimes intellectually. I often wonder how I would feel if I had been a vulnerable child who knew nothing but an abusive family or a family who found itself for one reason or another incapable of giving me the nurturing that I needed to develop. Children's development is seriously affected by these traumatic experiences, after which they are dragged away from the only family they know, inadequate though it may be. Very often—usually—the parents love their children but are unable to give them the care that they need.
	Such children are put in public care and are given a corporate parent. There is one big problem with corporate parents: you cannot cuddle them. That is why we try to find foster, substitute or adoptive families by preference for children in such care. That is right and as it should be. Unfortunately, it cannot always be done and children have to spend some or all of their time in care in residential homes.
	We cannot expect children to fulfil their educational potential if they are not at ease with themselves and the world. I believe that not enough attention is being paid to the mental health and well-being of children in public care. I am pleased that Ofsted inspections will report on how far schools contribute to the well-being of children, including their attainment, personal development, care and support. It would be nice to know that local authorities will also be assessed on the level of support that they give to those students—sadly just a few—who go to university.
	Last week I attended a meeting run by the Frank Buttle Trust and chaired, I believe, by our colleague the noble Baroness, Lady Howe. Unfortunately she is not able to take part in this debate. While it was very inspiring, it really brought home to those of us who attended how few young people go on to university from public care and what a struggle they have had to get there. It is also important, once they are at university, that they are given adequate support by their local authority. Two young people talked about how they are different because they have a flat of their own; they do not have families to go home to in the recesses. Money is short. Their experiences are different from those of the other students with whom they share lectures. Often they do not have a lot in common with them, and because so few students have been in care, they cannot easily find other students to share their common experience. They greatly appreciate a good local authority that gives them someone to turn to, thus providing a little extra support and encouragement in their studies.
	If we want to reach the Government's targets on educational attainment for children in public care, we must take several steps back from the school itself and look at what we must call the child's home context, the residential home. Many staff in care homes for children are wonderful people doing an excellent job, but like the noble Earl, Lord Listowel, I was interested to read about the approach taken in Denmark. It is a model to be followed. I read an article about the Josephine Schneider House in Copenhagen. Its approach results in an atmosphere different from that in our own residential homes, and the outcomes are also completely different. In Denmark, 60 per cent of children in public care go on to higher education, so they must be doing something right.
	What is the difference? They do not have any rules; children are treated as individuals. Staffing levels are high and the staff are well trained pedagogues. Pedagogy in this context is not just the science of teaching, but can be described as the process of nurturing the development of a child or young person based on a profound set of principles about what constitutes human flourishing and well-being. Personal creativity is emphasised, with plenty of art, music and drama to enable young people to express themselves and to acquire the capacity to make strong and easy relationships with others. One of the key aspects of staff training is how to create close relationships with the children while remaining professional at all times. In the UK it is all about targets and paper chasing, and I think we can learn a great deal from the experience in Denmark.
	Training for social work here is all about the law, procedures, targets, minimising risk and keeping children safe. We do quite well in keeping children safe once they are in public care, although there have been scandalous exceptions to the rule, but we are very risk averse and I cannot help feeling that that might be rather stifling. It gets in the way of the desirable strong personal relationships I mentioned earlier. There is a renewed interest in pedagogy among professionals here in the UK, and I wait with interest to hear what the Minister has to say about the Government's response to that renewed interest. It could indicate a new and very desirable approach.

Baroness Morris of Bolton: My Lords, I add my congratulations to the noble Earl, Lord Listowel, and I echo the comments of the noble Baroness, Lady Walmsley. This has been a thought-provoking debate with important contributions from all sides of the House on the issue of looked-after children as well as the situation in children's homes. The noble Earl took us through the harrowing histories of life for some young people in children's homes, but as always he reflected on and promoted the need for well qualified staff to lift standards. I was interested in the examples that he cited from abroad where the best professionals work with the most vulnerable, and I took on board absolutely what the noble Baroness, Lady Walmsley, said about Denmark—it sounded most interesting. As always, the noble Lord, Lord Ramsbotham, made a powerful speech on looked-after children in the criminal justice system, particularly in regard to the treatment of their mental health problems. Again, I agree with the noble Baroness, Lady Walmsley, on the damning indictment of the education results of looked-after children in our country.
	I welcome the start that has been made on the reform of standards for children's social care this June. It is clear that the industry is looking forward to change. As the chief executive of the Fostering Network said,
	"we want to make sure the new standards focus on outcomes and the experience of service users. There has been a concern that the current standards put too much focus on box ticking".
	I hope that the Minister will be able to update us on this consultation in his reply. After all, radical changes are needed to the system if it is to provide children with the best possible chance in life compared to the parents who too often have failed them.
	There are some excellent children's homes. The independent sector is now the majority provider of residential children's services, although, as we heard from the noble Earl, Lord Listowel, they are in turmoil. In the past 18 months, there have been significant shifts in the market—changes that the industry thinks have been ill thought out. But these homes provide high-quality care with dedicated and compassionate staff, the majority of which, as I have said, are in the independent sector. Evidence from the National Children's Bureau, which has a wealth of experience in residential childcare, shows, as the noble Baroness, Lady Walmsley, explained, that children can enjoy living in good residential establishments and that this can impact positively on their behaviour.
	I know from first-hand experience that some children feel safer and more secure in a children's home, where they have the camaraderie of their friends and carers and where their wariness and mistrust of adults can be patiently and sympathetically rebuilt. When I had been married for a few years, my husband and I decided to look into adopting. We had heard of two little girls, not related, who had formed a bond in care and whom the authorities would have liked to be adopted together if possible. We made all the inquiries, went through all the checks and had our home visit. We will always remember the words of the social worker as she left: "Just because you're well educated and live in a nice home doesn't mean you'll make good parents".
	Although we were put off pursuing events through our local authority, we went along to the Catholic Children's Rescue Society in Didsbury, Manchester. All the older children had made posters asking for a mum and a dad, but there was one poster from a boy in his early teens who did not want to be adopted or to go into long-term foster care because he had found happiness in his children's home and felt at home for the first time. All he wanted was a family who would have him for the weekend so that he could have a ferret. I often wonder if he found his family and his ferret—I so hope he did. I discovered that I was pregnant soon after this, and I should like to say to that social worker that I think we are pretty good parents, and our son had a ferret—three in fact.
	We on these Benches believe that in the hierarchy of childcare, however good it is, the removal of a child to a children's home should always be treated as the last resort, especially when kinship and concurrent programmes are showing such encouraging signs of success. However, we recognise that there will be individual children who will benefit from time in a children's home and that children's homes play a vital role, especially in short-term care. We also recognise that the choice of care should be dictated by what is best for the child and not by what is cheapest for the local authority. So it is in everyone's best interest—children, providers, social services, parents and extended family—that the homes are of the very best quality and offer choice and flexibility.
	It is also in everyone's interest that providers enter the market for the right reasons. As I understand it, you currently do not need planning permission if you want to set up children's home for six or fewer children. This has led to the development of clusters of private children's homes in residential areas, creating a significant shift in the community's dynamic. This has been especially noticeable in some coastal areas, where a combination of a lack of supervision and the removal of the child from familiar surroundings has led to that child becoming involved in anti-social behaviour and petty crime—the very negative cycle that we are often trying to break in removing the child from their family in the first place.
	As I have said, there are many good children's homes, owned and run by dedicated people, but a few are tempted by the high fees that they can charge—anything up to £3,500 a week in specialist children's homes. We must be careful that those who are motivated by money rather than the well-being of the children do not give the industry a bad name. I know that that is taken very seriously by the Independent Children's Homes Association, which believes that any company that breaks the rules should be dealt with swiftly by the regulatory regime.
	As at 21 March 2006, there were 1,388 independent children's homes registered with CSCI. These include 1,257 homes run by private providers and 131 homes run by the voluntary sector. In 2005–06, 284 homes deregistered. Deregistration can occur for a number of reasons, including the voluntary closure of a home, enforced closure resulting from regulatory action, change of ownership and change in the category of service provided. However, details relating to the reason for deregistration are not recorded, so we do not know how many enforced closures there were. Could that be changed?
	Inspection of homes has greatly improved, but it could be better. There needs to be less emphasis on the number of taps and the condition of the buildings and more emphasis on the ethos and quality of care. Dame Denise Platt, the chair of CSCI, is right when she says that the Government should be bolder and more radical in reforming the ways in which children's services are inspected. But the changes to the inspection regime mark the fourth change in social work inspection in seven years and we must be careful that this does not lead to a period of instability.
	I have a few questions that I would like to ask the Minister. Not all London boroughs have children's homes and, although I am not saying that they should, there is a strong case for greater co-ordination between them, especially when it comes to specialist services for dealing with those most in need. What steps are the Government taking to improve communication and co-ordination on this front?
	As your Lordships know, each looked-after child has a reserved, named social worker who is responsible for them. But when a child is moved far away from home, it is difficult for the social worker to keep a watchful eye on them if they have to travel miles to see them. Inevitably, the quality of the care and the relationship will suffer. How are social workers expected to monitor the well-being of the children in their care if it takes a day to get to them? We often forget to thank social workers for the tireless work that they do. Although I approve of the continuity in workers seeing a case all the way through, what feasibility is there to deal with these potential added burdens?
	Despite the fact that more children are in care than at any time over the past 10 years, there is still a serious shortage of child social workers, with vacancies in the thousands. We on these Benches have always promoted the importance of placement stability, not only for children in homes but for those in fostering and adoption programmes. It is important, particularly in the most vulnerable cases, to prevent children from being constantly moved from pillar to post. How would we feel—the noble Baroness, Lady Walmsley, touched on this point—if we suffered the trauma of being separated from our families, however inadequate those families may be, and then, when we were at our most vulnerable and fragile, also lost contact with our wider family, with our friends and with all that is familiar and comforting?
	We welcome the moves that the Government have made in this respect, but the changes are not being implemented fast enough. What steps are they taking to speed up this progress? As we have discussed in relation to recent children's legislation, attachment and belonging help to give children the confidence, resilience and sense of self that they so desperately need to develop into well rounded individuals.
	Flexibility in the care of children must be the key, through concurrent planning to kinship care to children's homes. On kinship care, there have been promising reports that children in kinship placements feel loved and wanted when living with relatives. They feel normal rather than different.
	I take the opportunity in every debate that I can to sing the praises of early intervention. We should ensure that our resources go to help families to stay together and that only as a last resort should children be taken into the care of the state. But when there has to be a last resort, that care should be of a high standard and the most appropriate for that child. Our children in care deserve no less than the care that we would wish for our own children.

Lord Adonis: My Lords, the noble Earl, Lord Listowel, speaks on the issue of children's homes with immense knowledge and personal commitment, which has been reflected in all the other speeches made in this short debate. The House is grateful to him for giving us the chance to discuss this important issue this evening.
	I start with some facts. At 31 March 2005, there were around 5,700 children in children's homes in England, which was around 9 per cent of the looked-after children population. At the same time, there were 1,985 children's homes of all descriptions, providing a total of 11,360 places, representing a significant oversupply. As the noble Baroness, Lady Morris, rightly noted, the average size of a children's home is under six places, and more than half of them have fewer than five places. The private sector is increasingly dominating the market. Most homes are run by private providers, with local authorities running only 34 per cent of homes and the voluntary sector only 6 per cent. So interaction between the public and private sectors in this area and proper commissioning arrangements, about which I shall have more to say, are absolutely vital for driving up standards. The old image of a children's home as one that is directly managed by a local authority is increasingly outdated, although the state directly manages custody arrangements for some of the most vulnerable looked-after children. The noble Lord, Lord Ramsbotham, referred to that, asking a specific question to which I shall have to reply separately. They are clearly vital to the well-being of the most vulnerable group of all among looked-after children.
	Performance remains highly variable. Children's homes, on average, now meet 74 per cent of the national minimum standards, compared with 56 per cent in 2002–03, which was the first year in which the standards were assessed. So there has been improvement, but improvement varies across sectors. Almost one in five voluntary sector homes were already meeting more than 90 per cent of the standards three years ago, compared with only one in ten for private sector homes and one in 20 for council homes. Around 27 per cent of private sector homes and 17 per cent of council homes now meet more than 90 per cent of the standards. While, therefore, the Commission for Social Care Inspection judges that there has been a threefold improvement, there remains scope for considerable further improvement in the sector.
	The simple answer to the question posed by the noble Earl is that quality improvement is the underpinning element in our strategy for children's homes. Looked-after children are among the most vulnerable and disadvantaged children in our society. They deserve and require good quality residential care to secure stability and achieve better outcomes. That is why we are looking, first, at what actions we can take to develop the residential care workforce, which has rightly been highlighted as a key priority; why, secondly, we are reviewing and improving standards, providing guidance, empowering local authorities better to protect the interests of those in their care and, since last year, funding a National Centre for Excellence in Residential Child Care, to which the noble Earl referred; thirdly, we have set a challenging national target for improving stability and raising educational attainment, and in the Children Act 2004 we introduced a new duty on local authorities to promote the educational attainment of their looked-after children, to meet precisely the unacceptable situation described by the noble Baroness, Lady Walmsley; fourthly, we are looking to ensure that provision is cost-effective and that we have an effective commissioning regime in place for improving provision.
	Those are the four key elements in our strategy for improving children's homes, and I shall say more about each in turn. First, on improving the residential care workforce, we are considering further issues affecting staff working in residential settings. Our future thinking about the workforce will build on the children's workforce strategy, which identified children's social care as one of the priority sectors for reform, as the noble Earl recognised in his remarks. That work is now being taken forward as part of the Options for Excellence review of the social care workforce, led jointly by my department and the Department of Health. It is charged with identifying creative but practical actions to increase the supply, and improve the quality, of social workers and social care workers, particularly in London and the south-east, where recruitment issues have proved especially challenging. We will have more to say about this in the proposals we will set out later this year on improving outcomes for looked-after children.
	Secondly, there is the issue of raising standards. As I have noted, evidence from inspection makes clear that the quality of care provided by children's homes is highly variable. We are currently reviewing the national minimum standards for children's social services. We will consider what changes are needed to the children's homes national minimum standards to allow the responsible regulator, currently the Commission for Social Care Inspection, to act more responsively and to target its activity where it can be most effective in raising the quality of care.
	The review will consider changes to regulation and inspection so that standards properly reflect recent legislative changes and recent developments in professional practice. For example, the revised national minimum standards will need to take account of the new framework for safeguarding children introduced following the Children Act 2004 and the latest requirements to improve planning for looked-after children; for example, the requirement that all care plan reviews must be chaired by an independent reviewing officer.
	In future, fuller compliance with revised standards will ensure that providers of services for looked-after children deliver the outcomes that we expect to see for all children so that those children are offered the care needed to reach their potential. We intend to provide all stakeholders, including children and young people themselves, with the opportunity to contribute to the review process. A full public consultation will be held on all key proposals relating to these national standards once they are published.
	Thirdly, with regard to improving educational performance, I am glad to say the figures given by the noble Baroness, Lady Walmsley, have been improved upon of late. If I give the figures, the House will understand how dire, frankly, the situation remains. It is now the case that 11 per cent of looked-after children got five or more A* to C GCSE grades in 2004–05, but that compares with well over 50 per cent for the population at large. The noble Baroness gave a figure of 1 per cent in respect of higher education. The latest figures I have are that 6 per cent of 19 year-old care leavers reached university last year. Again, that is a pitifully low figure compared to averages in the rest of the population, even among the most deprived parts of the non-looked-after part of the cohort.
	The White Paper we published last year makes clear that we expect the new School Improvement Partners, who now have a relationship with all secondary schools and will do so in due course with primary schools, to hold schools to account for how well they support looked-after children, and for improving their educational outcomes—not least those in children's homes.
	We have also been consulting on new regulations giving looked-after children top priority in school admissions, thus strengthening the existing code of practice. We have now gone further than that, and, as the noble Baroness, Lady Walmsley, noted, we have introduced government amendments to the Education and Inspections Bill to allow local authorities to direct schools to admit looked-after children, not only at the beginning of the academic year, but also outside the normal admissions round. We regard that change as of key importance, because looked-after children too often change their carers, including their children's home, outside the normal academic year. Ensuring that their transition into a school that suits their needs is as smooth as possible is of great importance to them.
	These reforms will underpin the new duty on local authorities in Section 52 of the Children Act 2004 to promote the educational achievement of looked-after children. However, formal admission to a school is only the first step in ensuring that looked-after children get a decent education. Local authorities should do what any good parent would do to promote their child's educational aspirations and achievements. As corporate parents who are responsible for the placement of children, local authorities should be ensuring that providers of residential children's homes meet, if not exceed, the prescribed children's homes national minimum standards relating to the support of education. The capacity of a placement to meet the assessed educational needs of the child must be absolutely central to deciding its suitability, whether this is in a children's home or any other type of placement.
	All children's homes should have clear written education policies setting out the arrangements for ensuring regular school attendance, high-quality support in areas such as homework and reading, robust monitoring of progress relating to the content of a looked-after child's personal education plan and effective liaison between the home, school and children's services department of the local authority making the placement. As the noble Baroness, Lady Morris, said, in many cases that will involve actual visits, but there are many other ways in which those responsible in the host local authority can take a keen and active interest in the ongoing progress of children in their care. We will have more to say about that also in the looked-after children Green Paper.
	Fourthly, we are working to address major challenges in cost, quality and commissioning. The overall cost of residential care has risen from £717 million to £920 million, a rise of over a quarter, in the three years from 2001–02 to 2004–05, although the number of children placed in the residential sector remained broadly static over that three-year period.
	As I have said, evidence from inspection makes clear that the quality of care provided by children's homes is variable. However, local authority commissioners are responsible for making sure that the costs of care are related to children's outcomes. The Commission for Social Care Inspection's recent report Making Every Child Matter: Messages from inspections of children's social services makes clear that,
	"children's social services commissioning arrangements are under-developed and they have little influence over the social care market . . . Placements are overwhelmingly spot-purchased with few preferred provider arrangements and uneven cost control . . . Contract monitoring is developing, but still limited".
	This is not a satisfactory situation. The Government are promoting a number of developments in relation to commissioning and contracting. In March this year, as the noble Baroness, Lady Morris, mentioned, we launched the Joint Planning and Commissioning Framework for Children, Young People and Maternity Services, which expands on statutory guidance for the Children Act 2004. Written with the assistance of those for whom the guidance is to be used, this sets the standard for how we expect commissioning in children's trusts to look in five years' time. Every local area is producing a children and young people plan, which sets out clearly how local outcomes will improve. We are providing support for children's services commissioners, including sharing of learning, toolkits, and direct help from commissioning and procurement experts. We are also aware that the Association of Directors of Social Services is developing a national contract for the placement of children and young people in children's homes. This, we understand, will be launched later this year. We are supporting this development. I will respond in writing to the many other points that have been raised, as I have run out of time.
	In conclusion, much is being done to ensure that all children and young people living in children's homes experience high standards of care, but there is more to be done. The Government, the inspectorate, local authorities and the national centre all have key roles to play in achieving improvement. We will continue to play our part in promoting reform and improvement.